Skiers thumb or thumb sprain is a thumb injury to the ulnar collateral injury often caused by a fall onto an outstretched hand forcibly pushing the thumb backwards beyond its tolerance range.
All joints have ligaments, which are strong bands of fibres passing across the joint holding the two adjacent bones together. The thumb joint has two main ligaments which are known as the ulnar collateral ligament, found on the web side of the thumb, and the radial collateral ligament, found on the outside of the thumb. In a fall onto an outstretched hand the thumb can be pushed backwards taking the ulnar collateral ligament beyond the point that it is able stretch to. Like an elastic band a ligament can stretch so far without damage, stretch further and the ligament may not recoil to its normal length, but remain lengthened and thus not be able to adequately stabilise the joint, stretch further still the ligament can snap, this is called a ligament rupture.
Causes of Skiers Thumb Injuries
The most frequent cause of skiers thumb or sprained thumb is a fall onto an outstretched hand forcing the thumb backwards. The chances of sustaining a thumb injury on falling is increased if there is anything in the hand at the time of the fall. A ski pole increases the risk of a skiers thumb injury as falling onto the pole causes the thumb to be pushed back further, or if the pole is caught in the snow behind then the leverage effect can pull the thumb backwards. A fall on a dry ski slope can also cause skiers thumb if the thumb is caught in the matting.
Any movement that forcibly pulls the thumb backwards can cause thumb sprain, and whilst a fall when skiing is a common cause thumb sprain is also seen after car accidents, or during ball sports such as netball where the ball forces the thumb backwards.
Although usually caused by a single accident skiers thumb injury can be caused by a repetitive motion of gripping and twisting building up to cause a chronic sprained thumb.
Symptoms of skiers thumb Injuries
- Pain at the base of thumb at the side of the web space between the thumb and the first finger.
- Swelling after a single injury at the base of the thumb
- Pain, weakness, or a feeling of lack of stability on gripping between the thumb and the index finger- for instance if turning a key in a lock.
- Bruising after a single injury along the inside of the thumb
- Pain when feeling around the base of the thumb on the web side
- Pain on moving the thumb
Treatment of Skiers Thumb Injuries
Treatment depends on the severity of the injury. Ligament sprains are classified according to severity:
- Grade 1 – Some stretching and tearing of the ligament, causes mild swelling, bruising and pain
- Grade 2 – A partial rupture of the ligament (some of the fibres of the ligament are snapped, but others are in tact). Causes a lot of bruising swelling and pain.
- Grade 3 – A complete rupture of the ligament (the ligament has snapped). This can cause the joint to be lax.
For a grade 1 skiers thumb a period of relative rest combined with ice and followed by appropriate exercise may be sufficient.
Many practitioners prefer a period of immobilisation in a cast or splint for a grade 2 injury again followed by exercise to decrease the likely hood of future injury
Surgery is usually the treatment of choice for a rupture, although this will be a personal choice depending on many factors such as any other health problems, whether the injury is on the dominant hand, what sports are enjoyed and type of occupation. However without surgery the thumb joint is likely to be unstable and may give difficulty and pain on day to day activities. Following surgery the thumb is immobilised for a time, after this appropriate exercise is important to strengthen and prevent the possibility of future injury.
Return to sport after skiers thumb
When first returning to sport after sustaining a skiers thumb injury it can be advisable to provide some extra support for the joint in the form of taping (strapping) the thumb, or the use of a thumb support.
Prevention of skiers thumb injury
There is no piece of equipment or fail safe method of ensuring prevention of skiers thumb injury on a fall. However the technique of holding the ski pole is critical. Many people now advocate not using the strap on the pole at all, this means that on a fall the pole can be easily discarded. This may be possible on recreational piste skiing, but of course increases the risk of either dropping the pole and loosing it when skiing or injuring others. It is important when using the strap to ensure that this is done with the correct hold as shown on the sheet at the top of the page.
Disclaimer: The information on this page is written to help you understand your injury. All injuries and different and should you have any concerns you should always seek advice from a qualified health professional such as a Chartered Physiotherapist or your GP.
